常规免疫策略的定期强化（强化免疫行动“彩虹计划”）是否降低了印度儿童抗生素制剂的需求？
Did the periodic intensification of routine immunisation strategy (Intensified mission Indradhanush) reduce the demand for pediatric antibiotic formulations in India?
作者信息
Farooqui Habib Hasan, Karan Anup, Mehta Aashna, Babu Giridhara Rathnaiah, van Schayck Onno C P
机构信息
Department of Population Medicine, College of Medicine, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
Public Health Foundation of India, KIIT Campus, Sohna Road, Gurugram, 122001, India.
出版信息
BMC Infect Dis. 2025 May 24;25(1):741. doi: 10.1186/s12879-025-11082-3.
BACKGROUND
Recent research has indicated an increase in antibiotic utilisation, particularly pediatric formulations. Furthermore, an increasing trend in antimicrobial resistance rates has also been reported. Empirical evidence suggests that immunisation reduces the demand for antibiotics. We examined the potential impact of the periodic intensification of the routine immunisation strategy - Intensified Mission Indradhanush (IMI), which was implemented from October 2017 to January 2018, on antibiotic utilisation in India.
METHODS
We analysed the PharmaTrac dataset to assess the impact of IMI on antibiotic utilisation. We conducted interrupted time series analyses by fitting a Poisson regression model. We used Newey-West standard errors to account for autocorrelation and heteroskedasticity.
FINDINGS
Poisson segmented regression analysis showed a 12.6% decrease in Fluoroquinolones sales in the first month of IMI implementation (incidence rate ratio [IRR] 0.874, 95%CI: 0.777-0.983). However, post-intervention, their sales remained broadly constant (IRR 1.000, 95%CI 0.995-1.006). Similarly, Chloramphenicol sales decreased by 0.6% in the first month, whereas sales increased by a trend of 0.4% per month (IRR 1.004, 95%CI 0.991-1.017) post-intervention. Interestingly, Trimethoprim sales increased by 17.1% in the first month but decreased by 0.4% per month (IRR 0.959, 95%CI 0.945-0.973) post-intervention. However, there was a modest increase in sales of Macrolides by 3.0%, Cephalosporins by 2.9% and broad-spectrum Penicillin by 0.2% in the first month. Thereafter, Macrolides sales increased by a monthly rate of 0.5% (IRR 1.005, 95% CI 1.000-1.010), Cephalosporins increased by 0.5% (IRR 1.005, 95% CI 1.000 -1.010) and Broad spectrum penicillin increased by 0.9% (IRR 1.009, 95% CI 1.004-1.013) in the post-intervention period. Furthermore, there were heterogeneities across Indian states.
INTERPRETATION
The IMI's impact on antibiotic utilisation was heterogeneous across antibiotic classes and Indian states.
背景
近期研究表明抗生素使用量有所增加，尤其是儿科制剂。此外，也有报道称抗菌药物耐药率呈上升趋势。经验证据表明免疫接种可减少对抗生素的需求。我们研究了2017年10月至2018年1月实施的常规免疫策略强化版——强化英德拉丹努什行动（IMI）对印度抗生素使用的潜在影响。
方法
我们分析了PharmaTrac数据集以评估IMI对抗生素使用的影响。我们通过拟合泊松回归模型进行中断时间序列分析。我们使用纽韦-韦斯特标准误来处理自相关和异方差问题。
研究结果
泊松分段回归分析显示，在IMI实施的第一个月，氟喹诺酮类药物销售额下降了12.6%（发病率比[IRR]为0.874，95%置信区间：0.777 - 0.983）。然而，干预后，其销售额基本保持稳定（IRR为1.000，95%置信区间0.995 - 1.006）。同样，氯霉素销售额在第一个月下降了0.6%，而干预后销售额每月呈0.4%的增长趋势（IRR为1.004，95%置信区间0.991 - 1.017）。有趣的是，甲氧苄啶销售额在第一个月增长了17.1%，但干预后每月下降0.4%（IRR为0.959，95%置信区间0.945 - 0.973）。然而，大环内酯类药物销售额在第一个月适度增长了3.0%，头孢菌素类药物增长了2.9%，广谱青霉素增长了0.2%。此后，大环内酯类药物销售额每月增长0.5%（IRR为1.005，95%置信区间1.000 - 1.010），头孢菌素类药物增长0.5%（IRR为1.005，95%置信区间1.000 - 1.010），广谱青霉素在干预后阶段增长了0.9%（IRR为1.009，95%置信区间1.004 - 1.013）。此外，印度各邦之间存在差异。
解读
IMI对抗生素使用的影响在抗生素类别和印度各邦之间存在差异。
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